People fear HIV/AIDS because of the association with sex, drugs, illness, and death. In South Asia, the epidemic is driven largely by high risk practices – buying and selling sex, injecting drugs, and unprotected sex among men having sex with men. This compounds the fear and stigma around HIV/AIDS, as sex workers, injecting drug users, and men having sex with men are already stigmatized.

Not only in South Asia, but around the globe, efforts to prevent new HIV infections and allowing people with HIV/AIDS to live without the burden of social exclusion are severely hampered by the persistence of stigma. One study in India shows that 36% percent of students, faculty and technical staff of the public health services felt it would be better if HIV-positive individuals killed themselves and believed that infected people deserved their fate; 34% would not associate with people with AIDS; 42% believed that those with HIV should be quarantined; and, 31% favored barring infected students from college classes (Ambati, Ambati & Rao, 1997[3]).

But the problem goes beyond the personal impact on individuals and their families. By driving underground those most at risk of infection and those living with the virus, stigma and the resulting discrimination makes it difficult to provide preventive and treatment services that are needed to break HIV transmission (e.g., HIV testing, condoms, clinical treatment for sexually transmitted infections and HIV, and needle exchange for injecting drug users). This further fuels the epidemic.

For those living with HIV, stigma is a problem in three ways. First, if concern about social and professional rejection makes people fearful to learn their HIV status, efforts to offer testing will be less effective and they will continue to spread their virus unknowingly. Second, if those who know they are HIV positive fear stigma and rejection, they might refrain from using condoms with their regular partner – often their spouses – to avoid the risk that the partner will suspect that they are living with HIV. Third, positive mothers have been known to refrain from obtaining the health care they need because they fear that if neighbors learn that they are HIV positive their ability to continue to earn a living–or their children’s ability to continue in school and play with their friends – will be threatened.

Dealing with stigma is not easy, but what better way than to ask civil society groups for their ideas on how to do it, and then choosing the best ones in the marketplace of ideas. The winners of the Development Marketplace were announced in Mumbai on May 15, 2008. Twenty-six civil society organizations from across South Asia won grants[1] of US$40,000 each to try out innovative ideas to reduce stigma and discrimination associated with HIV/AIDS. The well-known Indian actress and social activist Shabana Azmi presented the awards, noting that “this initiative is a small but very important step in the fight against stigma and discrimination.” The Marketplace was sponsored by the Government of Norway, the Swedish International Development Cooperation Agency, UNAIDS, UNICEF, and the World Bank and IFC.